AB-0224: Pediatric Dental Anesthesia

AB 224 (Thurmond) would increase the safety of children undergoing anesthesia in dental offices by implementing the Dental Board’s recommendations concerning pediatric dental anesthesia, including that children under 7 receive anesthesia from a separate anesthesiologist while the dentist performs the procedure so that the anesthesiologist may focus only on administering the anesthesia and monitoring the child for signs of dangerous adverse reactions.

The American Academy of Pediatrics, California (AAP-CA), representing over 5,000 California pediatricians, is proud to sponsor AB 224 (Thurmond). This bill would increase the safety of administering anesthesia and sedation to children in outpatient settings by requiring the implementation of the California Dental Board’s recommendations regarding safe access to dental anesthesia for children, including (among others) that a dedicated anesthesia monitor, separate from the operating dentist, be present when a child under age 7 undergoes general anesthesia or deep sedation. The bill would also update the permit structure for dental sedation and anesthesia in California and the definitions of sedation and anesthesia contained within California statue in order to conform with modern terminology.

The mission of the AAP-CA is to protect and promote the health and well-being of all children and youth living in California. Pediatricians have no financial interest in who administers and monitors anesthesia in a dental office. Our interest stems solely from our mission to protect and promote children’s health and well-being.

The American Academy of Pediatrics, in conjunction with the American Academy of Pediatric Dentistry, has published national guidelines that set a standard of care for children undergoing sedation and anesthesia for dental procedures. These guidelines recognize that young children “are particularly vulnerable to the sedating medication’s effects,” including its rare but dangerous side effects. Their airways are smaller, and they need more anesthesia in order to remain still during painful procedures. Due to this increased vulnerability, the guidelines call for a second qualified provider to be solely dedicated to the task of monitoring a child during deep sedation and general anesthesia, as in every other health care profession in California.

This dedicated monitor must be able to evaluate and recognize warning signs early, and must be capable of assisting in an emergency event affecting a child under the age of 7—which means they should have the skills and experience necessary to assess, resuscitate, and provide supportive measures for a child experiencing a life-threatening adverse reaction to anesthesia. Dental assistants and dental sedation assistants play valuable roles in dental offices but are not trained or qualified to perform this highly specialized and complex task, any more than they would be qualified to perform the same task in a hospital or a surgical center.

We decided to sponsor this legislation because we believe that all children, regardless of income, deserve one standard of care when they require sedation and anesthesia. The California Dental Board has recognized the need for higher standards of care for our state’s youngest residents by recommending further safety measures be taken in the administration of pediatric dental anesthesia, which would help bring state law in line with the AAP-AAPD guidelines. AB 224 (Thurmond) would do right by our state’s children by requiring a qualified dedicated monitor for any child under age seven when they undergo deep sedation and general anesthesia in dental offices and by updating the anesthesia permitting system in dentistry to more closely adhere to current definitions and safety recommendations.

Pediatricians across the state of California respectfully urge an AYE vote on AAP-CA’s sponsored legislation, AB 224 (Thurmond). Thank you for your public service and leadership on behalf of the health and wellbeing of children, youth, and families in California.

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